An intriguing question
The other day I was complaining (again) about the steep hike in my insurance premiums when someone asked me, “Why don’t more people sign up for the health-sharing co-ops?”
“What do you mean,” I asked. “The new Obamacare CO-OPs?”
These non-profit health insurance companies received start-up grants and loans to provide more competition with not-for-profit and for-profit health insurance companies on the exchanges. They are available on about half of the exchanges. Their rates will still be comparable to other companies, though, because of the mandated benefit coverage (more benefits = higher premiums).
“No,” he said. “The Christian-based co-ops, the health-sharing ministries. I’ve used one for years because I don’t want to buy an expensive individual plan. There’s a small monthly membership fee, and I pay cash for office visits and tests, but at a reduced rate because they negotiate discounts with all the providers. I have to pay costs up to $5,000 a year, which I’ve never had to, but if something big happens, they’ll cover everything over the $5,000. It’s great.”
“Really?” I was skeptical. “I”m not sure that will still be allowed under the individual mandate. It’s not really health insurance.”
“Oh, it’s allowed. They have an exemption. Anyway, it works for me, and I’ve been wondering why no one mentions it with all this talk about finding affordable health care.”
I didn’t know, either, but decided to find out more about these health-sharing ministries.
Do like the Amish
Because this was a casual conversation with a relative stranger, I wasn’t able to pump him for more information. But I was intrigued. I had heard of these kinds of cost-sharing arrangements, and had just assumed they would cease to exist after January 1, 2014.
Apparently not. These plans will continue to be offered and anyone who uses them will receive an exemption from the Affordable Care Act (ACA)–the religious exemption.
The most well known health-sharing ministries are:
- Samaritan Ministries (A Biblical, non-insurance approach to health care needs)
- Medi-Share Christian Care Ministry (Christians Have a Choice!)
- Christian Healthcare Ministries (The biblical solution to healthcare costs)
To satisfy the ACA, these ministries need to have been in existence since 1999, members cannot be refused based on age or health, and members cannot be rejected if they become sick/injured. The ministries must also undergo an annual, independent audit.
Eligibility and cost-sharing plans are somewhat similar among the groups. A member must be a Christian and agree to live by Christian principles. A reference from a priest or minister may be required, or proof of tithing. Any health condition resulting from “non-Christian” behaviors, such as substance abuse, smoking cessation, pregnancy outside of marriage, some forms of birth control, etc., may not be covered.
Members pay a monthly fee based on family size, not age. They are expected to pay upfront for ordinary medical services, such as routine exams, occasional doctor visits, screening tests, and prescription medications. The ministries work through third-party agencies to negotiate discounts with provider groups.
In the event of high medical costs that reach the plan’s agreed-upon out-of-pocket maximum, the health-sharing kicks in and covers 100% of “eligible” expenses.
Plans may include caps on expenses per event.
It’s kind of like insurance, but…
In some ways, these health-sharing ministries are more in line with traditional insurance. You pay a small monthly amount against the small risk that you might need a large amount of money to cover a future expense. Like paying car insurance in case your car is totaled in an accident, or house insurance in case your house burns down.
Health insurance today is more like a pre-paid health plan, I think. We pay ever larger monthly premiums to cover smaller, routine expenses such as annual exams, immunizations and screening tests, but still want to be covered in case of a ruinously-expensive health catastrophe (and it doesn’t take much now, does it?)
Still, these health-sharing programs are not insurance and are not regulated by a state’s insurance commissioner. They are not legally-binding contracts like an insurance plan, and any guarantee that they will consider any or all expenses “eligible” must be taken, well, on faith.
Health-sharing ministries are an option for those in faith communities, especially anyone who finds premiums under Obamacare to be unaffordable and does not qualify for a subsidy.
However, as with any health care policy, I would caution you to thoroughly research financial risk and benefit–know exactly what you are buying into–before joining the group.